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mHealth and Public Health Another Look: Vast Potential to Improve Delivery of Public Health




Our Take:


[In November 2023 we wrote about the challenges of mHealth in addressing public health, please see mHealth: Challenges Remain to Enable Providers to Address Public Health this week we look at the potential for mHealth to improve public health access.]


Mobile Health (mHealth) apps have emerged as a transformative force in the healthcare industry, significantly impacting public health in various ways. These applications leverage the ubiquity of smartphones and the power of digital technology to improve healthcare access, patient engagement, and health outcomes. Although these apps have the ability to improve access and convenience while reducing barriers to care, recognizing and addressing, where possible, the barriers to broadband access are essential steps in maximizing their benefits. If done correctly, the ongoing integration of mHealth into healthcare systems holds great promise for the future of public health.


Key Takeaways:


  • Approximately 71% of app users are estimated to disengage within 90 days of a new activity (Journal of Medical Internet Research)

  • As of July 2023 there were over 54,000 mHealth apps on the Apple App Store and over 65,000 mHealth apps on the Google Play Store (InApp.com)

  • A recent survey of 500 elderly respondents in South Korea found that seniors defined as “frail” were more likely to use such apps to get healthcare information and seek medical guidance than those defined as “healthy” (Journal of Korean Medical Science)

  • There were approximately 2.7M residential fixed wireless connections in 2021 (latest available data), an increase of over 70% from the prior year, off an admittedly low base (FCC)


The Problem:


While Mobile Health (mHealth) apps have made significant strides in improving public health, they also come with several challenges and problems that need to be addressed. First and foremost is the problem of unequal access, more commonly called the digital divide. Despite smartphones being nearly universal, everyone with a smartphone uses it to access the internet and many lack access to high-speed internet connections, resulting in the aforementioned digital divide that limits the reach and impact of mHealth apps. This is particularly true for the elderly as well as people residing in poor and rural areas. As noted in the article Commercial mHealth Apps and Unjust Value Trade-offs: A Public Health Perspective ”   developers of mHealth apps often ignore differences in the socio-economic position of their users resulting in power asymmetries within healthcare.” Though this may not be as large of a concern when app developers are targeting higher income populations like those with commercial insurance, it is essential to address these constituencies for those dealing with public health as vulnerable populations, such as low-income individuals or the elderly, may be left behind.


In addition there is the problem of low user engagement. Many users download mHealth apps but stop using them after a short time, leading to limited long-term health benefits. For example, a 2022 article in the Journal of Medical Internet Research noted that “approximately 71% of app users are estimated to disengage within 90 days of a new activity”. According to the study, a number of factors including lack of support, technical difficulties and usefulness of the app contributed to the low retention. Many mHealth apps offer a one-size-fits-all approach, failing to adapt to individual user needs, preferences, and goals. Without personalization, users may not find the app relevant to their specific health concerns, which can lead to disengagement over time.


Some problems may be attributed to varied App Quality. The mHealth app marketplace is flooded with apps of varying quality. As noted in the article Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis “It is evident that situational effects create some kind of general perception of risk because they inhibit the effective impact of mobile health apps on lifestyle behaviors, such as weight loss or physical activity.” Some apps may provide inaccurate information or unreliable health advice, potentially putting users' health at risk. For example, reminders and other behavioral “nudges” from weight loss apps may provoke a feeling of inadequacy and guilt inadvertently triggering inappropriate responses in people who have or may have had eating disorders. One article noted about a participant, who "starts punishing herself for not exercising by eating less. Although [she had] not been diagnosed with an eating disorder or anorexia she is certainly at risk since the use of fitness apps correlates with increases in distorted eating and exercising behavior.”


The Backdrop:


Although mHealth apps have been around for a number of years, their usefulness and value has only come to be a reality in the last several years in the context of several overarching societal and technological trends that have impacted the healthcare ecosystem.


While the emergence of mHealth was predicated on the proliferation of smartphones, mHealth really did not begin to realize its potential until the COVID pandemic. One article noted “the COVID-19 pandemic accelerated the adoption of telemedicine and remote care solutions, with mHealth apps playing a critical role in facilitating virtual consultations, monitoring, and remote diagnostics.” Another study highlighted that “mHealth [was] used for various aims, such as fast screening, early detection, contact tracing of infected people, appointment booking, remote monitoring of patients, clinical patient care, patient monitoring, and treatment in response to the COVID-19 outbreak.” Based on these experiences, public health officials have become knowledgeable on how to leverage mHealth to “allow patients to easily obtain health information and receive medical care, thus reducing the frequency of patient visits to the hospital and minimizing population mobility in areas of high risk. Mobile health apps effectively promote information exchange, storage, and delivery, and they improve the ability of patients to monitor and respond to diseases.” As a result, mHealth can help improve public health by creating readily accessible tools for healthcare management and information.


MHealth also helps address the issue of the rising costs of care. Escalating healthcare costs combined with the need for more efficient and cost-effective healthcare solutions has helped drive the development and use of mHealth apps. As illustrated in, Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective,  "the emergence of mHealth apps [have] changed the supply mode of health services and brought about benefits for both healthcare providers and recipients. On the one hand, doctors use mHealth apps to process patient information and monitor patient health. On the other hand, individuals use mHealth apps to obtain health information for immediate diagnosis." These apps aim to reduce the burden on traditional healthcare systems by enabling remote care and self-management of health conditions.


It improves telemedicine and Remote Care. The COVID-19 pandemic necessitated social distancing and reduced in-person healthcare visits, leading to a surge in demand for remote care solutions. Telemedicine, which had been steadily growing, saw unprecedented adoption as healthcare providers sought safe and efficient ways to connect with patients. In the article The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective it says, "Therefore, many countries have begun to use mHealth apps on a large scale to provide consultation, monitoring, and care services for patients. Mobile health apps allow for the exchange of two-way data between patients and healthcare personnel to realize remote medical consultation, psychological consultation, health education, and obtain medical protection. It meets users’ utilitarian medical needs. Satisfaction with utilitarian needs can positively affect user intentions." The COVID-19 pandemic accelerated the adoption of telemedicine and remote care solutions, with mHealth apps playing a critical role in facilitating virtual consultations, monitoring, and remote diagnostics.


Historically one of the issues in installing broadband in low income and rural communities has been return on investment for telecommunications companies given the high infrastructure costs. However, the advent of fixed wireless and 5-G technology may make broadband deployments in these communities more feasible. For example, according to the Federal Communications Commission’s “2022 Communications Marketplace Report”, there were approximately 2.7M residential fixed wireless connections in 2021 (latest available data), an increase of over 70% from the prior year, off an admittedly low base. While this accounts for only 2.4% of connections in the U.S. given the deployment cost of fixed wireless we would expect subscriber gains to continue. In addition, when combined with the speed advantages of 5G (or fifth generation wireless technology) we would expect to improve the attractiveness of fixed wireless networks over time as well (5G generally requires shorter distances between connections). Moreover, “with its promise of lightning-fast data exchange and minimal latency, 5G has the potential to revolutionize medical practices, enhance patient care, and drive innovation in the field. 5G also has significant implications for addressing rural health. “Patients in remote or underserved areas benefit significantly from 5G-enabled telemedicine. They can virtually connect with medical experts regardless of geographical constraints.


Implications:


As noted in the aforementioned Journal of Medical Information article, “using apps for remote assessment allows participants to make fewer site visits, substantially reducing the burden of travel and the time needed to participate in laboratory studies. With lowered barriers, it becomes easier for participants to conduct repeated testing and share real-time data based on their daily life experiences, …which may enhance both the effectiveness of the app in its goals (eg, in disease management) and adherence in research studies” 


As a result, the use of remote care enabled by mHealth reduces healthcare costs associated with physical infrastructure and travel, making healthcare more cost-effective for both patients and providers. In addition, mHealth can improve the public health management of chronic conditions as “chronic diseases, but not health crises, often manifest in the form of health management routine. In this case, the use of mobile health apps helps to address the health concerns of individuals who are already aware of their health condition.”


Lastly, not only can mHealth be used for new and innovative ways to deliver care, it can also be used to maintain continuity of care: As highlighted in the article, The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective, ”mHealth apps effectively promote information exchange, storage, and delivery, and they improve the ability of patients to monitor and respond to diseases. They can also be used for training, information sharing, risk assessment and symptom self-management”.


As a result of all of the above it appears clear that the potential for public health to leverage mHealth to broaden access, improve care and reduce the total cost of care is attainable in the near term if done correctly. However, as noted in “The digital divide in access to broadband internet and mental healthcare” this is particularly difficult in rural areas, “because rural businesses and homes are located far apart from one another, installing fiber-optic cables across many miles for a small number of paying customers presents internet service providers with the challenge of geographical barriers and a limited profit margin.” However, 5-G and fixed broadband technology may provide a quick and more financially viable potential solution to this issue.


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